Working it

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I love being an emergency doctor. I cannot think of anything I would rather do, except a lifetime of pootling in my garden. Despite being meek and mild and terrified of pretty much everything, I seem to have found my home in the emergency department. Amazingly I love the chaos, the noise, the carnage that is about to hit at any moment, the constant stress, split second decisions, the incredible team and the camaraderie. I really like very sick patients, alongside patients that I can fix and send on their way. A few stitches, a quick manipulation and a plaster cast and they’re on their way. Or patients who need every resource we have available to keep them alive just a little bit longer. Entering medical school I would never have predicted this for a second, but this has become my beloved second home. The very best things about the job? No bleep to make my heart race, and when I leave at the end of my ten hour shift there is always somebody else to take over responsibility. When I walk out of there, I can usually leave it all behind.

But fuck me, this is a hard job! I haven’t watched Casualty in a while, but what I remember of it could not be any further from the truth. I do not have the time to resolve my patients’ family feuds, or their love lives. I am not a professional matchmaker and counsellor. Despite many of my patients’ preconceptions, this is not a shop where you can come and demand the X-ray, scan, drug or procedure that you can’t be bothered to wait for. It is not my main role to smile and offer you and all the family you have brought with you, a cup of tea and a plate of biscuits.

Life has changed a lot in the ten years since I first started here. It is now the norm to have the corridor lined with trollies, to have patients waiting on those trollies for twelve hours until we can find them a bed on a ward. It has become standard practice to take histories and examine patients in a corridor in front of a host of other patients and their relatives. We get fined if we put a female onto a male bay in the main hospital but it’s ok for us to ask patients about their bowel habits in front of a crowded audience.

Its easy to become detached. You have to become detached. If I carried every patient with me, their hopes and fears, the impact on their wives and husbands, their children and parents, I would be crushed within days. If I worried about every decision I made, scared about every patient I sent home, I would become completely paralysed. I have felt it happen, and I have definitely seen it cripple others. I have seen people tie themselves in knots and admit every single patient they see, just in case. Though obviously hospital admission and endless tests comes with different  risks and I can’t afford to forget that.

Despite me carefully developing my heartless bitch stance, there are patients that will never leave me. The middle aged lady with a huge tumour, that was fungating through her skin and bleeding heavily. I was the first person she had ever told, ever shown it to. She had never found the right time, always having to be available and strong to support everybody else in her family. The baby brought in blue and stiff when they never woke up for their next feed. The man fighting for every last second of his life as we had to forcibly hold him down desperately trying to get lines and tubes into him, to give him that very faint chance of survival. Having to hold his wife up as she made the long walk to the resus room to see her husband for the last time, crying whilst all the eyes of the people in the corridors watch her silently. The familiar face of friend or family who comes in unexpectedly to horrible news. Even in my sleepy corner of the world I have looked after shootings, stabbings, hangings and drownings. I have looked after mass casualties from motor vehicle accidents. More assaults and suicide attempts than I could ever keep track of. I see some of the very worst of humanity at times. In the past week I have had to attend training on child abuse, modern slavery, domestic abuse, female genital mutalation, radicalisation and terrorism. These are things I am expect to always suspect in the back of my mind with every patient that I see.

And with all these cases I do what I can, write my notes, and then click onto the next patient in line. I leave the resus room to find fifty patients in the department, thirty of whom are waiting to be seen with a four hour wait. Then I have to put the smile on my face, apologise for the long wait, and try to listen to whatever is concerning them, whether that be the tickly cough that has been bothering them for the past six months, which they haven’t found the time to see their GP about, the drunk who spits and swears at me, or the old lady with a broken hip who apologises for wasting my time.

In one article published in a cardiology journal, the average life expectancy of doctors is 76 years. For ED doctors that falls to a terrifying 57, the shortest of any medical specialty. Sometimes after a run of particularly rough nights I’d be amazed if I make it that far.

Seriously though, I do love my job and wouldn’t want to do anything else, and I am so grateful to all my team members who keep me going and who keep choosing ED however tough it sometimes feels. I love you guys ❤

 

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